What matters in medical training in Wales: a thematic analysis of Wales-specific responses to the NHS England Medical Training Review Call for Evidence

Abstract Background Postgraduate medical education in the United Kingdom is delivered within health services experiencing sustained workforce shortages, workload pressure, and reduced supervisory capacity. National evidence has highlighted concerns around staffing, burnout, training quality, flexibility, and progression, but Wales-specific qualitative synthesis remains limited. This study aimed to identify and interpret key themes arising from the Wales-specific responses to the NHS England Medical Training Review Phase 1 Call for Evidence and to situate these findings in relation to wider UK medical education and workforce evidence. Methods This qualitative study used thematic analysis of Wales-specific free-text responses from the NHS England Medical Training Review Phase 1 Call for Evidence. The dataset comprised responses from 133 respondents who identified with, or commented on, the Welsh medical training context. Analysis involved inductive coding within the broad question-led domains of the parent survey and drew on reflexive principles. Findings were compared at the theme level with the broader Medical Training Review Call for Evidence summary and General Medical Council State of Medical Education and Practice workplace evidence. Results Eleven cross-cutting themes were identified: training capacity and workforce pressures; recruitment, progression, and career development; geographical stability and flexibility; training quality, supervision, and protected educational time; workload, wellbeing, and flexibility; equity and inclusion; curriculum modernisation; service-training conflict; community and interface training; digital infrastructure and artificial intelligence; and system-level reform. The strongest alignment with broader evidence concerned workforce capacity, supervision constraints, service pressure, and structural reform. Wales-specific responses added contextual depth by showing how these pressures were experienced in relation to place-based retention, progression from non-training roles, and the displacement of training by service demand. Conclusions Wales-specific responses to the NHS England Medical Training Review indicate that concerns about medical training in Wales are closely connected to wider UK workforce and training pressures yet shaped by the Welsh service and workforce context. Reform should address training capacity, workforce planning, protected educational time, equitable progression, flexibility, and sustainable working conditions as interdependent features of postgraduate medical education.